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Feeding > How to Choose What to Feed

How to Choose What to Feed

This page discusses when to introduce certain foods and what milk to give infants initially to prevent food allergies, asthma and eczema.

For many years it was recommended to limit early introduction of certain highly allergenic foods to decrease the development of food allergy, eczema and asthma. Newer research is finding the opposite advice may be true. Introduction of high risk foods in infants who are at low risk of allergy, and even in those at high risk but with negative testing for allergy, seems to be protective and helps prevent development of allergy.

In a nutshell:

  • Breast milk is preferred the first year of life
  • Hydrolyzed formulas might be beneficial over traditional formulas
  • Delay all foods until 4-6 months
  • Avoid foods that a child has shown a reaction to
  • If breastfeeding and the infant is allergic to a food, the mother should avoid that food
  • Begin peanuts between 4 and 11 months IF a baby does not have family history of peanut allergy or significant eczema. Talk to your pediatrician first if there are risks identified.
  • More research is still needed

Who is at risk for food allergies?

Babies who have a parent or sibling with allergy, eczema or asthma are at high risk of developing those conditions.

Do I need to avoid certain foods during pregnancy or lactation?

In their review of medical literature, they did not find benefit for pregnant or breastfeeding mothers to limit their diet from any foods (including milk, eggs and nuts) to prevent allergic disease. However, if an infant is already allergic to a food, an allergic reaction might happen if the breastfeeding mother eats that food. A mother of an infant with known allergies should avoid those foods.

Breastfeeding can help prevent allergies

There is evidence that breastfeeding for at least 4 months prevents or delays eczema, cow milk allergy and wheezing in children. (However it is not proven to prevent asthma after 6 years of age.) Babies who have a parent or sibling with allergy, eczema or asthma are at high risk of developing those conditions.

What if I’m not breastfeeding?

If you have a family history of any allergies, food intolerance, acid reflux, or eczema, a hydrolyzed formula instead of a standard cow's milk formula (see below) may prevent or delay development in those conditions in that child. Extensively hydrolyzed formulas may be more effective than partially hydrolyzed formulas (not more than breast milk), but more studies on their cost effectiveness need to be done. Soy formulas did not show a benefit to prevent allergic disease or eczema.

When to start foods

It has been common practice to delay the introduction of solid foods until 6 months, and to delay highly allergic foods until 2-3 years of age to decrease allergic disease. Reviewing the studies did not support waiting beyond 4-6 months for any foods. Although more studies need to be done, at this time it does not appear that delaying any foods thought to be highly allergic (cow milk, fish, eggs, and nuts) offers any benefit.

Begin foods at 4-6 months. Any food in any order is appropriate, as long as it is healthy for the baby and does not pose a choking risk. Do not give honey to infants under 12 months.

Does organic matter?

There is not enough evidence to recommend organic food, since the nutritional components of the foods are similar regardless of how they were farmed.   

Organically grown foods do have lower pesticide residues than conventionally farmed produce, but it is debated if this is significant or not to overall health.  Conventionally farmed produce have the pesticide levels monitored, and they fall within levels that are felt to be safe.

Organic farming rules also dictate no food additives or added hormones, which is also an area of study for health risks and benefits, but not enough data is available to give an educated opinion yet.  

Organic farming is generally felt to be better for the environment, but the sustainability of that is questioned.  

Organic farming might increase the risk of bacterial and fungal contamination or heavy metal content, so it is very important to wash fresh fruits and vegetables well prior to cutting or eating (as you should with all fresh foods).  

For more information, see the USDA site.

A backyard garden can be inexpensive, organic, and a great way for your kids to learn about growing and preparing healthy foods! 

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